On the effect of labour durations using an anisotropic visco-hyperelastic-damage approach to simulate vaginal deliveries

Pouca, Maria Vila; Ferreira, João; Oliveira, Dulce; Parente, Marco; Mascarenhas, Teresa; Jorge, R.M. Natal

doi:10.1016/j.jmbbm.2018.08.011

Cited by 15 publications

(15 citation statements)

References 21 publications

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“…Finite-element models of vaginal delivery commonly include only the levator ani muscles, the major components of pelvic organ support that maintain the genital hiatus, which may be adequate for certain research questions [6][7][8][9]. However, they generally exclude superficial perineal structures-such as the bulbocavernosus, ischiocavernosus and deep and superficial transverse perinei-striated muscles with high connective tissue content that are superficial to the levator ani and intersect at the perineal body [2,10] (figure 1).…”

Section: Introductionmentioning

confidence: 99%

Novel simulations to determine the impact of superficial perineal structures on vaginal delivery

et al. 2019

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This study's aim was to determine whether the inclusion of superficial perineal structures in a finite-element simulation of vaginal delivery impacts the pubovisceral muscle and perineal body, two common sites of birth-related injury. The hypothesis, inferred from prevailing literature, was that these structures would have minimal influence (differences less than ±10%). Two models were made using the Visible Human Project's female cadaver to create a rigid, fixed pelvis, musculature held by spring attachments to that pelvis, and a rigid, ellipsoidal fetal head prescribed with an inferior displacement to simulate delivery. Injury site stretch ratios and fetal head and perineal body displacements and angles of progression were compared between the Omitted Model (which excluded the superficial perineal structures as is common practice) and the Included Model (which included them). Included Model stretch ratios were +107%, −9.84% and −14.6% compared to Omitted Model perineal body and right and left pubovisceral muscles, respectively. Included Model peak perineal body inferior displacement was +72.5% greater while similar anterior–posterior displacements took longer to reach. These results refute our hypothesis, suggesting superficial perineal structures impact simulations of vaginal delivery by inhibiting perineal body anterior–posterior displacement, which stretches and inferiorly displaces the perineal body.

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Section: Introductionmentioning

confidence: 99%

Novel simulations to determine the impact of superficial perineal structures on vaginal delivery

et al. 2019

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“…The soft tissues of the pelvic floor are considered as nonlinear, incompressible, anisotropic and time-dependent materials. Vila Pouca et al [11,12] analysed the time-dependent behaviour of the pelvic floor muscles during delivery and confirmed that it influenced the delivery outcomes; however, the time dependency was neglected in the present work [11]. The pelvic floor muscles were then modelled as quasi-incompressible transversely isotropic hyperelastic solids [13,14].…”

Section: Constitutive Laws Of the Finite-element Modelmentioning

confidence: 58%

“…In order to ensure the accuracy and reliability of these three-dimensional models, appropriate verification and clinical validation are essential [32], which should include the experimental validation of individual tissues and the system as a whole. As stated in previous work, it is possible that the calibration of the model with experimental data from specimens that do not adequately represent the behaviour of the material in vivo and during gestation/labour has led to an apparent independence of the damage with the stretch rate and the prediction of high amounts of tissue damage [12].…”

Section: Discussionmentioning

confidence: 99%

Episiotomy: the biomechanical impact of multiple small incisions during a normal vaginal delivery

et al. 2019

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Childbirth-related injuries are one of the main causes of pelvic floor dysfunction. To attempt to avoid serious tears during delivery, an episiotomy can be performed. In this study, we intended to investigate the biomechanical performance of the pelvic floor muscles after performing different episiotomies using a physics-based computational model which includes the pelvic floor muscles and the fetus. Previous biomechanical studies have analysed the mechanical effects of single incisions of different lengths; in this study, we intend to analyse the implications of multiple small incisions, evaluating the reaction forces, the stress on the muscles and the loss of tissue integrity sustained by the pelvic floor. The obtained results predict that an episiotomy delivery reduces the likelihood of macroscopic levator trauma by decreasing the stress on the region of insertion of the rectal area of the levator ani in the symphysis pubis . From the mechanical point of view, multiple incisions do not bring benefits compared to larger incisions. However, nothing can be ascertained about the clinical benefit of such an approach.

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“…In comparison with the models of maternal pelvic floor muscles, which have been built based on detailed in vivo data, the fetal portion of computational birth models has been greatly simplified. Most fetal models only consist of a fetal head [11][12][13][14]16,17,21,23,25,26,31,[46][47][48][49][50][51][52][53], fewer fetal models have a representation of the fetal body [20,29,[34][35][36][37][38][39][40][42][43][44][54][55][56], and even fewer include articulation of any joint structures [22,45,[57][58][59]. Even among those models that include the whole fetal body, generally only the delivery of the fetal head was simulated, not the whole body.…”

Section: Fetal Anatomy and Biomechanical Characteristicsmentioning

confidence: 99%

“…The 3D geometrical models built from these two types of data sources exhibited good agreement on the pubococcygeus, iliococcygeus, and a large portion of the coccygeus. These cadaveric pelvic floor data were adopted into a modeling framework developed by Jorge's group and appeared in multiple studies [29,[34][35][36][37][38][39][40][41][42][43][44]. Another major source of female pelvic floor cadaveric data is the visible human project.…”

Section: Introductionmentioning

confidence: 99%

Childbirth Computational Models: Characteristics and Applications

Chen

Grimm

2021

Journal of Biomechanical Engineering

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The biomechanical process of childbirth is necessary to usher in new lives – but it can also result in trauma. This physically intense process can put both the mother and the child at risk of injuries and complications that have life-long impact. Computational models, as a powerful tool to simulate and explore complex phenomena, have been used to improve our understanding of childbirth processes and related injuries since the 1990s. The goal of this paper is to review and summarize the breadth and current state of the computational models of childbirth in the literature – focusing on those that investigate the mechanical process and effects. We first summarize the state of critical characteristics that have been included in computational models of childbirth (i.e., maternal anatomy, fetal anatomy, cardinal movements, and maternal soft tissue mechanical behavior). We then delve into the findings of the past studies of birth processes and mechanical injuries in an effort to bridge the gap between the theoretical, numerical assessment and the empirical, clinical observations and practices. These findings are from applications of childbirth computational models in four areas: (1) the process of childbirth itself, (2) maternal injuries, (3) fetal injuries, and (4) protective measures employed by clinicians during delivery. Finally, we identify some of the challenges that computational models still face and suggest future directions through which more biofidelic simulations of childbirth might be achieved, with the goal that advancing models may provide more efficient and accurate, patient-specific assessment to support future clinical decision-making.

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On the effect of labour durations using an anisotropic visco-hyperelastic-damage approach to simulate vaginal deliveries

Cited by 15 publications

References 21 publications

Novel simulations to determine the impact of superficial perineal structures on vaginal delivery

Novel simulations to determine the impact of superficial perineal structures on vaginal delivery

Episiotomy: the biomechanical impact of multiple small incisions during a normal vaginal delivery

Childbirth Computational Models: Characteristics and Applications

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